04D2013511 CLIA NUMBER - WALGREENS #11781

Laboratory Demographics

  • CLIA Code: 04D2013511
  • Facility Name: WALGREENS #11781
  • Facility Address: 2964 W MARTIN LUTHER KING BLVD
    FAYETTEVILLE, AR
    ZIP 72704
  • Facility Phone: 501 313-8402
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KYLE C. CONNER
  • NPI Number: 1760803035
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2013511
LAB Type Pharmacy
Facility Name WALGREENS #11781
Street 2964 W MARTIN LUTHER KING BLVD
City FAYETTEVILLE
State AR
ZIP 72704
Phone 501 313-8402
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/10/2024
Certificate Expiration Date 8/9/2026
Facility Type Pharmacy
Lab Director KYLE C. CONNER

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This page was last updated on: 9/29/2025